Treatment of LDL-C

• Statins: every 1 mmol (39 mg/dL) ↓ LDL-C → 22% ↓ major vascular events (CV death, MI, stroke, revasc) in individuals w/ & w/o CAD (Lancet 2010;376:1670)
• Ezetimibe: ↓ major vascular events incl MI & stroke when added to statin post-ACS, w/ magnitude of benefit consistent w/ LDL-statin relationship (IMPROVE-IT, NEJM 2015;372:2387)
• PCSK9 inhibitors: ~60% ↓ LDL-C on top of statin, as monoRx, and in FH (EHJ 2014;35:2249); ↓ CV outcomes (NEJM 2017;376:1713 & 2018;379:2097)
• In homozygous FH: apheresis; evinacumab (ANGPTL3 inhib) ↓ LDL-C by ~50% (NEJM 2020;383:711)